This document discusses abruption placentae, which is premature separation of a normally situated placenta, causing bleeding. It has an incidence of about 1 in 200 deliveries. It can be revealed, concealed, or mixed. Risk factors include high birth order, advancing age, hypertension, and trauma. Clinical features depend on whether it is revealed, concealed, or mixed. Diagnosis is mainly clinical with ultrasound and labs. Management includes prevention, emergency measures like IV fluids and blood, and either immediate delivery, managing complications, or expectant management depending on the situation. Nursing interventions address pain management, fluid volume deficit, ineffective tissue perfusion, risk of anemia and infection, and fetal hypoxia.

1. AKSHAYA R NAIR

2. AKSHAYA R NAIR

3. DEFINITION
IT IS ONE OF ANTEPARTUM HEMORRHAGE WHERE THE
BLEEDING OCCURS DUE TO PREMATURE SEPARATION OF
NORMALLY SITUATED PLACENTA.

5. INCIDENCE&SIGNIFICANCE
 ABOUT 1 IN 200 DELIVERIES
 PERINATAL MORTALITY(15 TO 20%)
 MATERNAL MORTALITY(2 TO 5%)

7. REVEALED
THE BLOOD INSINUATES DOWNWARD THE MEMBRANES AND
DESIDUA.THE BLOOD COMES OUT THE CERVICAL CANAL TO BE
VISIBLE EXTERNALLY.

8. CONCEALED
THE BLOOD COLLECT BEHIND THE SEPERATED PLACENTA OR
COLLECTED IN BETWEEN THE MEMBRANES.THE COLLECTED
BLOOD IS PREVENTED FROM COMING OUT THE CERVIX BY
PRESENTING PARTS ON LOWER SEGMENT.

9. MIXED
SOME PARTS OF THE BLOOD COLLECTS
INSIDE(CONCEALED) AND A PART IS EXPELLED OUT
(REVEALED).

12. ETIOLOGY

13. 1.HIGH BIRTH ORDER
PREGNANCY
WITH
GRAVIDA 5 OR
MORE

14. 2.ADVANCING AGE

15. 3.HYPERTENSION
SPASAM OF THE
VESSELS IN THE UTERO
PLACENTAL
BED,REPTURE OF THE
VESSELS ,FORMATION
OF RETRO PLACENTAL
HEMATOMA

16. 4.SHORT CORD
EITHER RELATIVE
OR ABSOLUTE,CAN
BRING ABOUT
PLACENTAL
SEPARATION
DURING LABOUR BY
MECHANICAL PULL.

17. 5.TRAUMA
TRAUMA CAN OCCURS
DUE TO EXTERNAL
CEPHALIC VERSION,
RTA,NEEDILE
PUNCTURE AT
AMNIOCENTESIS

18. 6.SUDDEN UTERINE
DECOMPRESSION
DIMINISHED THE SURFACE AREA OF THE UTERUS
ADJACENT TO PLACENTAL ATTACHMENT AND RESULT
IN SEPARATION

19. 7.TORSION OF UTRES
INCREASED VENOUS PRESSURE AND REPTURE OF THE
VEINS WITH SEPERATION OF PLACENTA

20. 8.UTRINE FACTOR
PLACENTA IS IMPLANTED OVER A SEPTAM OR
ASUBMUCOUS FIBROID

22. COUVELAIRE UTERS

23. CLINICAL FEATURES

24. PARAMETERS REVEALED MIXED
SYMPTOMS ABDOMINAL DISCOMFORT OR
PAIN FOLLOWED BY VAGINAL
BLEEDING(SLIGHT)
ABDOMINAL ACUTE INTENSE
PAIN FOLLOWED BY SLIGHT
VAGINAL BLEEDING THE PAIN
BECOME CONTINUOS
BLEEDING CONTINOUS DARK COLOUR
(SLIGHT TO MODERATE)
CONTINOUS DARK COLOUR OR
BLOOD STAINED SEROUS
DISCHARGE
GENERAL CONDITION PROPORTIONATE TO THE
VISIBLE BLOOD LOSS,SHOCK IS
USUALLY ABSENT
SHOCK MAY BE PRONOUNCED
WHICH IS OUT OF
PROPORTION TO THE VISIBLE
BLOOD LOSS
PALLLOR RELATED WITH VISIBLE BLOOD
LOSS
SEVERE AND OUT OF
PROPORTION TO THE VISIBLE
BLEEDING
FEATURES OF PREECLAMPSIA ABSENT FREQUENT ASSOCIATION

25. F
UTERINE FEEL NORMAL FEEL WITH
LOCOLIZED
TENDERNES,CONTRACTIONS
UTERUS IS TENSE, TENDER
&RIGID
UTERINE HEIGHT PROPORTIONATE TO
GESTATIONAL AGE
MAY BE DIS PROPORTIONATE
,ENLARGED,
GLOBULAR
FETAL PARTS CAN BE IDENTIFIED EASILLY DIFFICULT TO MAKE OUT
FHS USUALLY PRESENT USUALLY ABSENT
URINE OUT PUT NORMAL DIMINISHED

26. DIAGNOSIS
MAINLY
CLINICAL,ULTR
SONOGRAPHY,
MRI

27. LABORATORY TEST REVEALED MIXED
BLOOD Hb LOW VALUE
,PROPORTIONATE TO
THE BLOOD LOSS
MARKEDLY ,LOWER
,OUT OF PROPORTION
TO THE VISIBLE BLOOD
LOSS
Coagulation profile Usually unchanged Variable changes:
CLOTTING TIME
INCREASED(>6MIN)
FIBRINOGEN LEVAL –
LOW(<150mg/Dl)
PLATLET COUNT LOW
URINE FOR PROTEIN MAY BE ABSENT USUALLY PRESENT

28. MANAGEMENT
PREVENTION
1 .Prevention of known factors
 Early detection and effective therapy
 Needle puncture
 Avoidance of trauma
 To avoid supine hypotension
 routine administration of folic acid

29. TREATMENT
ASSESSMENT
a) AMOUNT OF BLOOD LOSS
b) MATURITY OF THE FETUS
c) WHEATHER THE PATIENT IS IN LABOUR OR NOT
d) PRESENCE OF ANY COMPLICATION
e) TYPE AND GRADE OF ABRUPTION

30. EMERGENCY MEASURES
1. BLOOD (HB,COAGULATION PROFILE)
2. RINGER’S SOLUTION DRIP IS STARTED
MANAGEMENT OPTIONS ARE:
1. IMMEDIATE DELIVERY
2. MANAGEMENT OF COMPLICATION
3. EXPECTANT MANAGEMENT

31. IMMEDIATE DELIVERY
THE PATIENT IN LABOUR
LABOUR IS ACCELERATED BY LOW RUPTURE OF THE MEMBRAES,OXYTOCIN
DRIP MAY BE STARTED TO ACCELERATE LABOUR
VAGINAL DELIVEY IS FAVORED IN CASE WITH
1. LIMITED PLACENTAL ABRUPTION
2. FHR REASSURING
3. PLACENTAL ABRUPTION WITH DEAD FETUS
THE PATIENT NOT IN LABOUR
a) INDUCTION OF THE LABOUR
b) CESAREAN SECTION

32. a) INDUCTION OF THE LABOUR
LABOUR IS QUICKELY COMPLETED (4-8HOURS)
RETRO PLACENTAL CLOT IS EXPELLED SIMULTANEOUSLY WITH
DELIVERY OF BABY
Inj.OXYTOCIN 10.IU IV(SLOW),OR Inj.METHERGINE 0.2 Mg IV GIVE
….P
b) CESAREAN SECTION
INDICATIONS ARE;- SEVERE ABRUPTION WITH
LIVE FETUS,AMNIONECTOMY COULD NOT BE DONE
,AMNIONECTOMY FAIL TO CONTOROL BLEEDING,

33. EXPECTANT MANAGEMENT
BLEEDING IS SLIGHT AND STOPPED,
THE GOAL OF THE EXPECTANT MANAGEMENT IS PROLONG THE
PREGNANCY WITH HOPE OF IMPROVING MATURITY AND SURVIVAL.
PATIENT SHOULD BE MONITER IN THE LABOUR WARD FOR 24-48 Hrs
to.
FURTHER SEPARATION OF THE PLACENTA MAY CAUSE FETAL DEATH
AND MATERNAL COMPLICATION..

34. NURSING DIAGNOSIS
ACUTE PAIN RELATED TO UTERINE CONTRACTION AS EVIDENCED BY
PAIN SCALE SCORE ,VERBALIZATION
FLUID VOLUME DEFICIT RELETED TO EXESSIVE VASCULAR LOSS
SECONDARY TO BLEEDING AS EVIDENCED BY HYPOTENSION,SHOCK
INEFFECTIVE UTERO PLACENTAL TISSUE PERFUSION RELATED TO
ABRUPTIO PLACENTA AS EVIDENCED BY CHANGE IN FETAL HEART RATE
RISK FOR ANEMIA RELATED TO BLEEDING
RISK FOR INTRA UTERINE INFECTION RELATED VAGINAL BLEEDING
RISK FOR FETAL HYPOXIA RELATED TO PLACENTAL INSUFFIENCY

35. ACUTE PAIN RELATED TO UTERINE CONTRACTION AS
EVIDENCED BY PAIN SCALE SCORE ,VERBALIZATION
DETERMINE THE NATURE,SEVERITY,LOCATION AND DURATION OF THE
PAIN.
ASSESS FOR UTERINE CONTRACTIONS, RETROPLACENTAL HEMORRHAGE
OR ABDOMINAL TENDERNESS
ASSESS THE PSYCHOLOGICL STRESS AND EMOTION RESPONSE TO EVENT
PROVIDE QUIT ENVIRONMENT AND DIVERTIONAL ACTIVITIES
ADMINISTER PRESCRIBED NARCOTICS OR SEDATIVES

36. FLUID VOLUME DEFICIT RELETED TO EXESSIVE
VASCULAR LOSS SECONDARY TO BLEEDING AS
EVIDENCED BY HYPOTENSION,SHOCK
REPORT AND RECORD AMOUNT ND THE NATURE OF THE BLOOD LOSS
INSTRUCT THE PATIENT TO TAKE STRICT BED REST
NOTE VITAL SIGNS
MONITER UTERINE ACTIVITY,FETAL STATUS,AND ABNORMAL
TENDRNESS
RECORD INTAKE OUTPUT
ADMINISTER IV SOLUTIONS INCLUDING PLASMA EXPANDERS,WHOLE
BLOOD AS PER DOCTORS ORDER
AVOID RECTAL OR VAGIAL EXAMINATIONS

37. INEFFECTIVE UTERO PLACENTAL TISSUE PERFUSION
RELATED TO ABRUPTIO PLACENTA AS EVIDENCED BY
CHANGE IN FETAL HEART RATE
NOTE MATERNAL PHYSIOLOGIC STATUS AND BLOOD VOLUME
AUSCULTATE AND REPORT FHS
RECORD MATERNAL BLOOD LOSS AND ANY UTERINE CONTRACTIONS
NOTE EXPECTED DATE OF DELIVERY AND FUNDL HEIGHT
ENCOURAGE BED REST IN LATERAL POSITION
ADMINISTER SUPPLEMENTAL OXYGEN TO CLIENT

38. RISK FOR FETAL HYPOXIA RELATED TO
PLACENTAL INSUFFIENCY
ASSESS THE FHR
ASESS THE FETAL MOVEMENT
ASESS THE MATERNAL BLOOD LOSS

39. BY AKSHAYA R NAIR